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HomeMy WebLinkAboutwell & boring record WELL LOCATION MINNESOTA DEPARTMENT OF HEALT ` ! MINNESOTA UNIQUE WELL NO. ) ;�..% County Name WELL AND BORING RECORD''7IfF 6 7 7 8 5 5 Hennepin Minnesota Statutes Chapter 103lnp r Township Name Township No. Range No. Section No. Fraction WELL DEPTH(completed) 3 ?7 , ���rte Work Completed Orono 117 23 5 144 `'I` r L,r. �f 5-29-02 House Number,Street Name,City,and Zip Code of Well Location or Fire Number DRILLING METHOD i7(?N//'''1 0 Cable Tool 0 Drivel?? ❑ Dug 372 Westlake St , Orono 55356 ❑ Auger ;rotary 0 Jetted Show exact location of well in section grid wilt . Sketch map of well location. 0 T�`w Showing property lines, roads and buildings. DRILLING FLUID WELL HYDROFRACTURED? El61 YES NO N `C __ i ---- J \\ super gel- FROM ft.to ft. 1 USE O Monitoring ❑ Heating/Cooling Fd'Domestic 0 Community PWS CI Industry/Commercial a o ❑ Irrigation ❑ Environ.Bore Hole ❑'Noncommunity PWS 0 Remedial w i E �` ff ❑ Dewatering 0 r r �� f' /ZM. I CASING Drive Shoe? 0 Yes C.No HOLE DIAM. ---- • � --- steel El Threaded ❑ Welded 1 ` \ JC lastic 0 S I ,oras I -_ CASING DIAMETER WEIGHT PROPERTY OWNER'S NAME 4 in.to tuft. sdr 21 lbs./ft. 77/@.to ft. Steiner & Koppelman in.to ft. lbs./ff.66 in.to."t'•ft. Property owner's mailing address if different than well location address indicated above. in.to ft. lbs./ft.© m.to fft. 18340 Minnetonka Blvd SCREEN OPEN HOLE Wayzata, MN 55391 Make Johnson from ft.to ft. J Type s t fen st ee 1 Diam. 2" Slot/Gauze .010 Length AS f 4 Set between 136 ft.and 144 ft. FITTIN S_2„a30" laader STATIC WATER LEVEL WELL OWNER'S NAME --42 AME _ ft. below 0 above land surface Date measured w/kp ' - � 5-24-02 PUMPING LEVEL(below land surface) Well owner's mailing address if different than property owner's address indicated above. 1 20 ft. atter 1 hrs.pumping 48 g.p.m. WELL HEAD COMPLETION trrhi t ewe t e ,'Pitless adapter manufacturerrode O Casing Protection [x/12 in.above grade O At-grade(Environmental Wells and Borings ONLY) / GROUTING INFORMATION Well grouted? Cp"Yes 0 No GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO Grout Material 0 Neat cement 0 Bentonite 0 Concrete 511-ligh Solids Bentonite MATERIAL from-_to____,30._ft. 3 0 yds. Ci#bags clayyellow soft 0 17 from 3p to 136 tt. natural- f ft. bags from to ft. G�iL�� y s bags NEAREST KNOWN SOURCE OF CONTAMINATION -j clay gray medium 17 43 70 1 feet SouTIE`� direction �pe Well disinfected upon completion? R'Yes 0 No coarse gravel white soft 43 47 PUMP f 0 Not installed Date installed 6-11-02 clay/gravel gray soft 47 63 Manufacturer's name Model number HP 1 . L 5 Volts 2 3J0 clay gray 63 94 Length of drop pipe 80 ft. Capacity g.p.m. 131 Type: ubmersible 0 L.S.Turbine 0 Reciprocating 0 Jet 0 gravel/clay gray soft 94 •7 ABANED WELLS Does property have any not in use and not sealed well(s)? 0 Yes 61No sand gray soft 131 144 VARIANCE �'C Was a variance granted from the MOH for this well? 0 Yes Qif o TN# WELL CONTRACTOR CERTIFICATION Use a second sheet,if needed This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. REMARKS,ELEVATION,SOURCE OF DATA,etc. The information contained in this report is true to the best of my knowledge. Don Stodola Well Drilling Co., Inc. 27172 Licensee Business Name Lic.or Reg.No. ./ !/ / ���� ' ' 7l . 4.71-.Se-..- -presentative.ig ire'- r- Date Nam o de/e Mathew 5 29-q .. - LOCAL COPY 6 7 7 6 5 5 HE-01205-07(Rev.2/99) IC#140-0020 nit)£vti C CtWer CLIn1Ic', I va c/. City at 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 05/31/2002 Stodola Well Drilling 3841 North Main St. Bonifacius MN 55375 938-2111 REPORT OF WATER ANALYSIS Lab #: 507 Our Laboratory reports these analytical results, determined on a sample taken by CLIENT on 05/29/2002 from the following location: 372 W. Lake St. Orono,Mn Unique Well #677855 Coliform Bacteria <1/100 ml Nitrates Nitrogen <1.0 mg/I The results of these tests indicate that this well is producing water that meets the standards for F.H.A., V.A., or conventional loans. This report is an analysis for coliform and nitrate only and does not include analysis of Lead and other contaminants. (Unless as specified by client). Tlv City Water Clinic, Inc. Bill Lab Certification#027-053-I 19